Henery Paul M, Dundas Ruth, Katikireddi S Vittal, Leyland Alastair, Wood Rachael, Pearce Anna
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, United Kingdom.
NHS National Services Scotland, Public Health Scotland, United Kingdom.
Lancet Reg Health Eur. 2021 Jul;6:100117. doi: 10.1016/j.lanepe.2021.100117.
Unintentional injury is a leading cause of death/disability, with more disadvantaged children at greater risk. Understanding how inequalities vary by injury type, age, severity, and place of injury, can inform prevention.
For all Scotland-born children 2009-2013 (n=195,184), hospital admissions for unintentional injury (HAUI) were linked to socioeconomic circumstances (SECs) at birth: area deprivation via the Scottish Index of Multiple Deprivation (SIMD), mother's occupational social class, parents' relationship status. HAUI was examined from birth-five, and during infancy. We examined HAUI frequency, severity, injury type, and injury location (home vs. elsewhere). We estimated relative inequalities using the relative indices of inequality (RII, 95% CIs), before and after adjusting for demographics and other non-mediating SECs.
More disadvantaged children were at greater risk of any HAUI from birth-five, RII: 1•59(1•49-1•70), 1•74(1•62-1•86), 1•97(1•84-2•12) for area deprivation, maternal occupational social class, and relationship status respectively. These attenuated after adjustment (1•15 [1•06-1•24], 1.22 [1•12-1•33], 1.32 [1•21-1•44]). Inequalities were greater for severe (vs. non-severe), multiple (vs. one-off) and home (vs. other location) injuries. Similar patterns were seen in infancy, excluding SIMD-inequalities in falls, where infants living in more disadvantaged neighbourhoods were at lower risk (0•79 [0•62-1•00]). After adjustment, reverse SIMD-gradients were also observed for all injuries and poisonings.
Children living in more disadvantaged households are more likely to be injured across multiple dimensions of HAUI in Scotland. Upstream interventions which tackle family-level disadvantage may be most effective at reducing childhood HAUI.
Wellcome Trust, Medical Research Council, Scottish Government Chief Scientist Office.
意外伤害是导致死亡/残疾的主要原因，处境更为不利的儿童面临的风险更高。了解不平等现象如何因伤害类型、年龄、严重程度和伤害地点而有所不同，可为预防工作提供参考。
对于2009年至2013年在苏格兰出生的所有儿童（n = 195,184），意外伤害住院情况（HAUI）与出生时的社会经济状况（SEC）相关联：通过苏格兰多重贫困指数（SIMD）衡量的地区贫困程度、母亲的职业社会阶层、父母的关系状况。对出生至五岁以及婴儿期的HAUI进行了研究。我们考察了HAUI的频率、严重程度、伤害类型和伤害地点（家中与其他地方）。在对人口统计学和其他非中介性SEC进行调整前后，我们使用不平等相对指数（RII，95%置信区间）估计了相对不平等情况。
处境更为不利的儿童从出生到五岁发生任何HAUI的风险更高，地区贫困、母亲职业社会阶层和关系状况的RII分别为1.59（1.49 - 1.70）、1.74（1.62 - 1.86）、1.97（1.84 - 2.12）。调整后这些数值有所减弱（分别为1.15 [1.06 - 1.24]、1.22 [1.12 - 1.33]、1.32 [1.21 - 1.44]）。严重伤害（与非严重伤害相比）、多次伤害（与一次性伤害相比）以及在家中发生的伤害（与在其他地点发生的伤害相比）的不平等现象更为严重。在婴儿期也观察到了类似模式，但在跌倒方面排除了SIMD不平等情况，即生活在更为不利社区的婴儿风险较低（0.79 [0.62 - 1.00]）。调整后，在所有伤害和中毒情况中也观察到了相反的SIMD梯度。
在苏格兰，生活在处境更为不利家庭的儿童在HAUI的多个方面更易受伤。解决家庭层面不利因素的上游干预措施可能在减少儿童HAUI方面最为有效。
惠康信托基金会、医学研究理事会、苏格兰政府首席科学家办公室。
